3/20 repro Flashcards
female: mature vs immature teratoma
- which one is malignant?
- which one more likely to have thyroid tissue?
- immature = malignant.
- in males, a mature teratoma can also be malignant.
- mature = thyroid tissue (struma ovarii)
granulosa cell tumor
-what can it secrete?
E & also P.
Call-Exner bodies
- what do they look like?
- what are they found in?
- resemble primordial follicles
- granulosa cell tumor
Psammoma bodies found in which ovarian neoplasm?
Serous cystadenocarcinoma
Pseudomyxoma peritonei = “jelly belly”
- what is it?
- seen in what ovarian tumor?
- intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor.
- Mucinous cystadenocarcinoma
Dysgerminoma
- appearance?
- markers?
- Sheets of uniform “fried egg” cells D.
- hCG, LDH = tumor markers.
Choriocarcinoma
- are villi present?
- presentation?
- where does it commonly spread?
- no villi present
- Presents with abnormal β-hCG, shortness of breath, hemoptysis.
- lungs
Choriocarcinoma: gestational v. spontaneous germ cell:
-which one responds well to chemo?
-gestational has good response to chemo.
Schiller-Duval bodies
- what do they look like?
- what disease they found in?
- resemble glomeruli
- yolk sac tumor
Yolk sac tumor
- tumor marker?
- most commonly found in who?
- AFP
- male infants
SCC of vagina
-usually secondary to what?
Cervical SCC
Lower 1/3 of vagina => which LNs?
-inguinal nodes
upper 2/3 of vagina => which LNs?
-iliac nodes
Adenosis
- what is it?
- what causes it?
- can lead to which cancer?
-During fetal development, the squamous cells from distal 1/3 vaginal canal extends and replaces columnar epithelium in rest of vaginal canal. If this
process is disrupted and columnar cells persist, called adenosis.
-Seen in association w/female fetuses exposed to DES (Diethylstilbestrol) drug in utero.
-Adenosis can lead to clear cell adenocarcinoma.
Adenosis
-what lead to which cancer?
-Adenosis can lead to clear cell adenocarcinoma.
Sarcoma botryoides
- benign or malignant?
- variant of what type of tumor?
-malignant
-rhabdomyosarcoma variant
-
Sarcoma botryoides
- who does it affect?
- marker?
- girls < 4yo
- spindle-shaped tumor cells that are desmin (+).
desmin
-what is it?
IF present in muscle cells.
myogenin
-what is it?
Txn factor in immature skeletal muscle.
Breast: is the terminal duct proximal or distal to lobules?
proximal.
- attached to lobules.
*terminal makes it sound like its distal.
Fibroadenoma
-hormone sensitive?
- yes
- bigger during pregnancy or luteal phase.
Fibroadenoma
- associated w/usage of what?
- pre or post-menopausal?
- cyclosporine A (immunosuppressant) usage.
- pre-menopausal
endodermal sinus tumor
-aka?
yolk sac tumor
Why do breasts grow during pregnancy?
Breast tissue responds to E & P by growing.
Intraductal papilloma
- benign or malignant?
- grows where?
- hallmark?
- benign.
- lactiferous ducts (typically beneath areola).
- serous or bloody discharge.
Most common cause of spont. nipple discharge?
Intraductal papilloma
Intraductal papilloma
- does it inc. risk for carcinoma?
- what about fibroadenoma?
- intraductal papilloma = slightly
- fibroadenoma = no inc. risk
Phyllodes tumor
- benign or malignant?
- appearance?
- presents in who?
- benign, but some may be malignant.
- Large bulky mass of connective tissue and cysts. “Leaf-like” projections.
- 60 year old female
Phyllodes tumor
-arises from what tissue?
-intralobular stroma of breast, not inside a duct.
malignant breast cancer
-usually arises from what part of the breast?
terminal duct lobular unit
triple negative (ER-, PR-, and Her2/Neu -) breast cancer -better or worse prognosis?
worse
-its more aggressive
Most important prognostic factor for breast cancer:
Axillary lymph node involvement indicating metastasis.
Malignant breast cancers
-which one = most commonly bilateral?
-lobular carcinoma in situ is most often bilateral.
BRCA1 & BRCA2
-marker for prognosis or susceptibility?
susceptibility
Her2/neu
-marker for prognosis or susceptibility?
prognosis
Medial breast drains to what LNs?
- Parasternal nodes
- Parasternal nodes on L and R communicate w/each other.
Ductal carcinoma in situ (DCIS)
-how is it detected?
microcalicifications on mammogram.
-growing inside duct - so its not displacing any tissue - so its not palpable.
Paget cells
-appearance?
-large cells in epidermis with clear halo
Paget’s disease of breast & vulva
-which one indicated an underlying malignancy?
Breast
-pagents of vulva just means there are malignant cells in the epidermis of the vulva, not any deeper.
Paget cells:
- stain for what?
- what type of cell is a paget cell?
PAS (+), keratin (+), S100 (-)
-all of thise are opposite of what you would find in a melanoma.
*paget cell = epithelial cell.
Orderly row of cells (“Indian file”)
-describes which breast cancer?
Invasive lobular breast carcinoma
Invasive lobular breast carcinoma
-loss of what gene product?
- Loss of E-cadherin, so no duct formation.
- E-cadherin: the glue that sticks epithelial cells together. Often the loss of this is what allows cancers to metastasize.
- gives it its “indian file” orderly row of cells.
Invasive lobular breast carcinoma
-unilateral or bilateral?
-often bilateral
Medullary breast carcinoma
- appearance?
- prognosis?
- fleshy, cellular, lymphocytic infiltrate.
- good prognosis
Inflammatory breast carcinoma
-whats happening?
- Dermal lymphatic invasion by breast carcinoma.
- Peau d’orange.
- neoplastic cells block lymphatic drainage.
Are cooper’s ligaments elastic?
no
BRCA1 mutation => predisposes most to which breast cancer?
Highest chance of getting medullary carcinoma of the breast.
Epithelium of ducts entering nipple
- require what vitamin to function properly?
- what is bad for this?
vitamin A
- its specialized epithelium.
- smoking
Fibroadenoma vs fibrocystic change:
- pain?
- unilateral vs bilateral?
- fibroadenoma = no pain
- fibroadenoma = typically singular lesion
Acute mastitis
- most common pathogen?
- Tx:
- S. aureus
- Dicloxacillin and continued breast-feeding.
Fat necrosis
-biopsy can show what?
-biopsy shows necrotic fat, giant cells.
Acute prostatitis/orchitis: cause
- men < 35:
- men > 35:
- men < 35: gonorrhea, chlamydia.
- men > 35: E.coli, pseudomonas
inc. in free PSA
- BPH or carcinoma?
BPH
BPH
-hyperplasia of glands, stroma, or both?
-both
Prostate adenocarcinoma
-markers?
- Prostatic acid phosphatase (PAP)
- inc. total PSA
- dec. free PSA
What type of bone lesions from prostate cancer metastasis?
-markers?
osteoblastic
- inc. ALP.
- inc. total PSA
- dec. free PSA
Cryptorchidism
-test. levels?
- unilateral = normal test.
- bilateral = dec. test.
95% of all testicular tumors are which type?
-and which is the most common testicular tumor?
- germ cell tumors
- seminoma = most common
How does testicular cancer present?
PAINLESS firm mass that can not be transiluminated.
Seminoma
- benign or malignant?
- who gets it?
- prognosis?
- malignant
- men in their 30s, NEVER in infancy!
- good prognosis, sensitive to radiation.
Seminoma
-appearance?
-Large cells in lobules with watery cytoplasm and a
“fried egg” appearance.
-placental ALP.
Most common testicular tumor in boys < 3 years old.
Yolk sac (endodermal sinus) tumor
Choriocarcinoma
- how does it spread?
- what makes it metastasize so quickly?
You don’t get villi, you just get the cells that normally line the villi (syncitio. and cytotropho). These cells are programmed to find blood, so this cancer spreads hematogenously very quickly.
How does choriocarcinoma cause gynecomastia?
bHCG is an LH analog.
Male: mature teratoma
- in a child: benign or malig?
- in an adult: benign or malig?
- child: benign
- adult: may be malignant
Embryonal carcinoma
- what is it?
- prognosis?
- marker?
-malignant germ cell testicular cancer
-worse than seminoma
-inc. hCG and normal AFP levels when pure (inc. AFP
when mixed).
Embryonal carcinoma
-appearance?
Malignant, hemorrhagic mass with necrosis.
Most testicular cancers are painless, which one is most likely to be painful?
Embryonal carcinoma
What are the 5% of testicular tumors that are NOT germ cell tumors?
Leydig cell tumor, sertoli cell tumor, testicular lymphoma.
Reinke crystals
-seen in what cell neoplasm?
Leydig cells
Most common testicular cancer in older men.
lymphoma metastasis to testicle.
-germ cell tumors arise in men ages 15-40.
Spermatocele
-what is it?
dilated epididymal duct
which meds can cause priapism?
-anticoagulants, PDE-5 inhibitors, antidepressants, α-blockers, cocaine.
fulvestrant
estrogen antagonist.
-no agonist effects.
Danazol
- mech:
- use:
- s/e:
- Synthetic androgen that acts as partial agonist at androgen receptors.
- Endometriosis and hereditary angioedema.
- dec. HDL, hepatotoxic
Testosterone
-effects on HDL & LDL.
- inc. LDL, dec. HDL
* opposite of estrogen.
Finasteride & gynecomastia
-connection?
-finasteride = causes build up of testosterone => more aromatization = more estrogen = gynecomastia.
Spironolactone
- hormonal effects?
- use?
- s/e:
- Inhibits steroid binding, 17α-hydroxylase, and 17,20-desmolase.
- Used in the treatment of PCOS to prevent hirsutism.
- gynecomastia and amenorrhea.
Ketoconazole
- hormonal effects?
- use?
- Inhibits steroid synthesis (inhibits 17,20-desmolase).
- Used in the treatment of PCOS to prevent hirsutism.
- gynecomastia and amenorrhea.
Sildenafil, vardenafil
-cause inc. in what?
cGMP
impaired blue-green color vision.
-which drug?
Sildenafil, vardenafil
-also dyspepsia.
Osteoprotegrin
- function?
- which cell secretes it?
- which drug mimics this?
- decoy receptor for RANK-ligand, so it prevents activation/differentiation of osteoclasts.
- secreted by osteoblast.
- denosumab.
RANK-ligand
-which cell expresses it?
osteoblasts.
-RANK receptor is on osteoclasts.
Housemaids knee
- which bursa?
- who’s it seen in now?
- pre-patellar bursa
- roofers, plumbers, carpenters.
succinylcholine
- how does it differ from ACh?
- what kind of paralysis does it cause?
- succinylcholine is NOT broken down by AChE.
- flaccid paralysis.
nicotinic receptor
-what kind of channel is it?
non-specific cation channel
-Na goes in, K moves out (may lead to hyperkalemia).
baclofen
muscle relaxant that affects GABAb channels.
Skin btwn great toe and 2nd toe
-cutaneous inn by which nerve?
deep peroneal
Most lethal cancer in men/women?
lung cancer
-but its not the most common.
Most common cancers in men and women?
-prostate & breast
intra-articular glucocorticoid injection
-can these cause systemic Sxs?
-not really
Besides exogenous glucocorticoids, which other drugs can cause iatrogenic Cushing syndrome?
protease inhibitors.
glioblastoma multiforme
- neoplasm of which cell?
- can it cross midline?
- astrocyte
- yes, it can cross midline.
Reticulin
- what type of collagen?
- whats it found in?
type 3 collagen
-blood vessels
Saturday night palsy
-which nerve?
Radial nerve.
-partying on sat. night is “RAD”.
Fx surgical neck of humerus & ant dislocation of shoulder
-what nerve is damaged?
axillary nerve.
parvovirus
-effects in adults?
rheumatoid arthritis-like Sxs
-type 3 HSR
herpes zoster
-Tx?
famciclovir
Which two substances drive angiogenesis?
VEGF & FGF
somatomedin C
-aka?
IGF-1
M line or Z line
-which one of them is the center? and what attaches to it?
M line in center w/attached myosin.
Hx of neonatal hepatitis
-think what disease?
A1AT deficiency
rouleaux formation
-think what disease?
Multiple myeloma
Scala vestibuli & tympani
-which one is first (ascending) & in contact w/oval window?
vestibuli is first.
-in contact w/oval window
scala vestibuli & tympani
-movement of perilymph in which causes movement of basilar membrane?
scala tympani
-in contact w/round window.
Cl conc.
-high or low in the cell?
low Cl conc. in the cell.
- if its channels were open, Cl would flow in.
- just like w/GABA receptor agonists, they allow Cl to flow in and hyperpolarize the cell.
Cl conc.
-high or low in the cell?
low Cl conc. in the cell.
- if its channels were open, Cl would flow in.
- just like w/GABA receptor agonists, they allow Cl to flow in and hyperpolarize the cell.
What neutralizes the positive charge of K in the cell?
proteins & phosphates
cachectin
-aka?
TNF-alpha
noise induced hearing loss
- damage to what?
- high or low freq lost first?
- stereociliated hair cells of the organ of corti
- high freq lost first
*acute intense noise can cause tympanic membrane rupture - so that would be an exception.
noise induced hearing loss
- damage to what?
- high or low freq lost first?
- organ of corti
- high freq lost first
Infectious mononucleosis
-what % of the time is it due to EBV?
EBV = 90% CMV = 10%
Corneal reflex
- afferent limb:
- efferent limb:
- afferent = CN 5 (V1 = opthalmic)
- efferent = CN 7 (closes eye)
